How often have you heard the phrase, “The United States has the best health care system in the world.”?
What is wrong with that statement is the word “system”.
We could rephrase it – The United States can deliver some of the best health care services in the world (to those who can pay for it).
We could even argue – The United States has some of the best health care systems in the world: the Mayo Clinic, the Veteran’s Administration, the Department of Defense.
But to assert that we have a system or that Americans (all Americans) receive the best care in the world is a stretch. Why?
Over the last two weeks I wrote about our fragmented health care system and the closely related fragmented payment system.
I wrote about how patients are equally fragmented, migrating during their lives through several health plans, what I call patient delivery systems.
Why does this matter?
In most measures of health system performance the United States ranks embarrassingly near the bottom or at the bottom among industrialized countries. From 2000 to 2009 male life expectancy fell six slots to 24th in the world and female life expectancy fell from 28th to 35th. Some would counter that life style, diet, or poverty had more influence on those drops than health care.
Isn’t that fragmented thinking? If we had a health care “system” then it would take comprehensive approach to population health.
What are the incentives for doctors and hospitals? Just as sunflowers follow the sun, health care providers, like the rest of us, follow the money. And the money is paid for doing stuff, surgeries and tests, for example. It is not paid for talking with or listening to patients, giving them lifestyle or treatment compliance assistance.
What are the incentives for patients?
Patients often lack the freedom to choose just any doctor. Their incentive is to change doctors to conform with their current health plan rules. Continue reading